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If you’re like me you may have acid reflux and not know it. Oh you know you’ve got something wrong, but not what’s causing it. And until you know what it is how can you know how to fix it? (want the shortcut to how to fix it? it’s here).

What is Acid Reflux?

In the old days it was called heartburn because some people feel a burning sensation behind their sternum (aka breastbone). Your esophagus meets your stomach at your diaphragm which separates your heart and lungs from your other organs, and all that happens at the end of your sternum. It’s got nothing to do with your heart, despite the name. (and don’t be stupid, if you’re having chest pain and you don’t know what’s causing it, see a doctor!).

There’s a sphincter there that allows food into your stomach, then closes behind it. Your stomach is, by design, very acidic. It turns that big steak into meat soup by the time it gets to the other end of your stomach. But your esophagus isn’t designed to deal with acid. It’s the job of the lower esophageal sphincter (the LES) to keep the two separated. When that sphincter isn’t doing its job acid leaks up into your esophagus and ouch!

Symptoms

People call it heartburn but not everyone has a burning sensation. I didn’t. So I didn’t think heartburn when I started having symptoms.

These days it’s called acid reflux or more technically, when it becomes a chronic condition, Gastroesophageal reflux disease (GERD). Reflux sounds to me like throwing up. I didn’t feel like anything was coming back up my throat, so again I discounted acid reflux as the cause of my troubles.

In my case I couldn’t catch my breath when my heart rate got elevated (more accurately when my breathing got faster, remember that the LES is at your diaphragm). I had a persistent heaviness in my chest, like a dog was sitting on me. When lifting weights or exerting myself it sometimes felt like someone punched me right at the base of my sternum. At one point I lost my voice for a few weeks. I could squeek for a few minutes, then I was done for (anyone who knows me knows how much THAT cramped my style!).

For 18 months I googled ‘shortness of breath’ and the like. Finally my husband noticed I coughed after I ate. “Coughing after eating” was the magical phrase that led me to hiatal hernia and then acid reflux. I felt pretty stupid for not figuring it out earlier, but then again I’d seen two internists, a cardiologist, a pulmonologist and they hadn’t figured it out either.

Hiatal Hernia

Not all reflux sufferers have a hiatal hernia, and not everyone with a hiatal hernia has reflux, but they seem to go together. They certainly do in my case. A hiatal hernia is when the top part of your stomach protrudes through the LES. That punched feeling behind my sternum when I lifted weights? Yeah. That was my stomach popping up through my LES.

Treatment

If you suffer from acid reflux and/or hiatal hernia there are very effective natural options. After 18 months of chronic breathing problems, once I figured out the root cause of my problem I felt better in 3 days. 3 days. I started eating less and eating earlier (so I had time to digest before sleeping), I stopped going upside down (think of the yoga position down dog, big no no), started sleeping on an incline, drinking slippery elm tea and chewing DGL tablets. 3 days. More details on these natural remedies, including a very simple exercise for hiatal hernias, can be found on my blog post here. I hope you find them useful.

As with most things in life it comes down to mostly common sense. Before I tell you all the things you can’t have or do let me say this:

Your body is designed to heal itself.

Your cells are regenerating every moment of every day, striving for health. If you give the body what it needs (which sometimes means just getting out of its way, especially with pharmaceutical drugs) it can often find its way back to a healthful state. 99% of the time now I’m completely symptom free. Once you get to that state (which took me several months) you may not have to be so strict.

Lifestyle:

If you do nothing else, do this. Drink Slippery Elm “tea”. Ok, it’s not tea, it’s gruel. But it works!

Slippery Elm has been used for centuries as a digestive aid and it’s highly nutritious (rumor has it Washington’s Army lived on it and even had their gunshot wounds treated with it). Just like it sounds it’s literally tree bark, of the Slippery Elm Tree. When mixed with water it makes a thick gelatinous concoction that coats your entire digestive system. I have a cup before bed anytime I even think my heartburn is going to kick up. It’s not only good for acid reflux, but also for other digestive problems like Irritable Bowel Syndrome and diverticulitis and diverticulosis and can be made into a poultice to treat burns and wounds.

Let it cool a bit (it’ll really hold its heat, watch out!) and enjoy. You can also blend with less hot water and stir in some room temp water to cool it down but it will blend easier with very hot water.

Yes, it’s slimy, but you get used to it. I enjoy it even. More importantly it works! Before bed is the best time to have a cup of slippery elm “tea”. Reflux often happens when we lie down simply because gravity isn’t helping to keep things down where they belong. So have a cup right before bed (& remember to sleep on your left side, &/or propped up).

By the way, the Slippery Elm pills you’ll find at places like Whole Foods won’t do the trick. You need the Slippery Elm to coat your esophagus, not make the trip all the way to your tummy. Don’t know why, read ‘What is Acid Reflux Anyway?‘.

The biggest problem making slippery elm tea is lumps. I’ve tried everything. Whisking. Shaking. Stirring. Hot water. Cold. First cold to make a paste then adding hot. There’s only one way, in my experience, to make beautifully smooth slippery elm tea. You’ve got to use hot water and use a blender, or a chopper attachment on an immersion blender.

Chew cinnamon gum. You’ll likely have to go to Whole Foods to find gum that doesn’t contain aspartame or sucralose. Look for gum sweetened with xylitol (good for your teeth, actually prevents cavities!) and/or stevia. I like the Between or Spry brands. Spearmint is often advised for tummy trouble but can weaken the sphincter between your esophagus and your stomach (the LES), and is NOT recommended. BEWARE! Most commercial gum is sweetened with aspartame, which is a whole other subject.

Avoid bending over, particularly after eating (hinge at the hips and bend at the knees to load that dishwasher!).

Sleep on your left side. Lying on your left side puts your stomach in a position less likely to send contents upwards. Sleeping on your back is the second best option, and on your right side is the worst option. Tummy sleeping is clearly out of the question!

Quit smoking. Smoking may weaken the LES and you don’t produce as much saliva, one of the ways the body protects the esophagus.

Sleep elevated. Prop the head of your bed up 4-6” with blocks (cheap first thing to try, although you might just slip to the end of the bed), use a wedge pillow (I never found one I really liked, I tried several and always slid down as the night wore on) or pile up some fairly firm pillows. If you use pillows like I did watch out for propping up the head and neck too much and letting your abdomen ‘sag’; make yourself a nice gradual incline.

Avoid regular use of NSAIDs such as aspirin, ibuprofen (Motrin, Advil, Nuprin, Rufen), Naproxen (Aleve), and others. Studies show regular users of NSAIDs are twice as likely to develop acid reflux disease. Say it with me in your best Mr. Mackey voice: Drugs are Bad!

Avoid unnecessary use of antibiotics. If you do have to take antibiotics, replenish your system with a good probiotic (yogurt isn’t enough to do the trick).

Hiatal Hernia Exercise

If, like me, your reflux is a result of a hiatal hernia (when the top of your stomach has popped through your diaphragm) there’s a simple but very effective exercise you can do to get your stomach to drop down back where it belongs.

First thing each morning drink a warm glass of water. Not hot. Not cold. Not coffee or tea. Warm water. On an empty stomach. Reach your arms out to the side. Let your stomach relax. Rise up on your toes. Then thump down onto your heels. Rise up. Thump. 10 times. Then take your arms overhead and pant – fast! – for 10 seconds. That’s it!

The warm water encourages your stomach to relax and gives it weight. Simple gravity helps the stomach drop down. Panting with your arms overhead encourages the diaphragm to tighten up and keep things in place.

Caution: Do not do this exercise if you have any disc issues in your spine as you’re putting a fair amount of force on your spine.

Diet:

Don’t eat too much at one time. This has the biggest impact on my symptoms. Much more so than any particular food I eat. If I overindulge, even in the healthiest food, I’m gonna pay for it.

Give yourself time to digest (3 hours) before going to bed.

Avoid the following:

Hot liquids and foods (temperature, that is). If you can’t hold it in your mouth, it’s too hot to go down your throat! Once you start doing the hold-in-your-mouth test you might be surprised how much piping hot stuff you’re sending down your esophagus!

Greasy and fried foods. Fat makes food digest slower, so food remains in your stomach longer, giving it more opportunity to go up instead of down. However, healthy fats (fish oil, nuts, olive oil) are vitally important to health and in my experience a meal of healthy fats (oven roasted salmon, for instance) and one of unhealthy fats (french fries) have very different reactions.

Caffeine

Chocolate (sorry, causes the LES to relax); I must admit this is the first place I indulge when I’m symptom free!

Hard alcohol (beer is ok for most people, and red wine seems to have a protective effect – yay!)

Peppermint and Spearmint. Peppermint is known for its tummy taming properties. But not when acid reflux is your problem, it relaxes the LES.

Carbonated beverages

Acidic foods: tomatoes, citrus

Spicy food

Raw onions and garlic – maybe. I’ve read both that onions and garlic are to be avoided, and because of the many health benefits, should not be avoided. Test it on yourself, see what happens.

Your triggers may be different than anyone else’s, and some of the foods above might be fine for you (for instance, I don’t seem to have a problem with spicy food). Pay attention to what aggravates you and what doesn’t. A food diary for a week or so is an excellent tool for determining what you should and shouldn’t eat.

Exercise:

Regular exercise is very important (for lots of reasons), but heavy weight lifting should be avoided as it can increase the pressure in the abdomen and force stomach acid up the esophagus. Bouncing (jogging, running, bouncing on a large exercise ball, jumping rope) is asking for trouble. Some say crunches or sit ups are also a bad idea. My personal experience doesn’t bear that out, but decide for yourself if it aggravates you. Basically any exercise that causes you to grunt or strain should cause you to say to yourself “hmm, I don’t think I should do that”.

No jogging? No weight lifting? Doesn’t that mean no exercise? Absolutely not!

Pilates! Pilates was certainly the answer for me when traditional weight training aggravated my condition. For almost two years Pilates was the only form of exercise I could do. Instead of spending five days a week in the gym killing myself with high intensity cardio and heavy weight training my reflux forced me to cut back to two days a week of Pilates (I didn’t know at the time that acid reflux was what was wrong with me, I only knew cardio and weight lifting caused me to have shortness of breath). Naturally I assumed I’d gain weight and lose muscle tone. Exactly the opposite happened. I lost weight (and have kept it off) and have gained muscle tone. Not without effort, certainly, but absolutely without grunting and straining.

You should avoid inverted positions (with your head below your stomach) but you can do most of the Pilates repertoire without aggravating reflux.

If yoga is your thing be sure to avoid anything inverted (“upside down”) like downward dog or headstands.

As for cardio, I highly recommend Nia, a non-impact form of aerobics, combining dance and martial arts kicks and blocks. It’s infinitely modifiable for your body and fitness level. But more than anything else, Nia is just plain fun! Or good old fashioned walking (the movement your body is most designed to do in my opinion).

Acid Reflux is a rampant problem. But modern medicine only wants to treat it. They don’t want to cure it. Why lose a repeat customer after all?

But you can “cure” it yourself in many cases. Naturally. Without Drugs. I did.

First, let’s define “cure”. I define it as lack of symptoms without having to use drugs to mask symptoms; you might always have to follow the lifestyle listed in the related post ‘Natural Cures for Acid Reflux‘.

Why bother curing it? Why not just take a pill for the rest of your life? First of all, it just makes common sense. Your stomach is designed to be an acidic environment. It turns a big steak into meat soup before it hits the rest of your digestive system. Just what do you think happens if it’s not allowed to do its job? You’re not absorbing nutrients for one thing. And you’re depriving your immune system of one of its major weapons for another (stomach acid doesn’t just liquify your food, it kills germs!).

Also, indigestion and heartburn is your body speaking to you, shouting to you even. STOP THAT! By taking drugs that only mask the symptoms, you’re only turning down the volume so you can ignore it and continue to do your body damage. It’s like walking around on a sprained ankle while taking Vicoden. Just because it doesn’t hurt any more doesn’t mean you should be doing it!

Then there’s the side effects of the drugs used to stop the production of stomach acid, or to counteract it. Not just nuisance side-effects like diarrhea, constipation, hemorrhoids and kidney stones. I’m talking serious, systemic changes to your body like osteoporosis and even cancer. You simply can’t go messing around with one of your body’s main organs and expect there not to be consequences. The studies are just starting to appear but Dr. Jonathan Wright and others foretold of these risks years ago:

The Canadian Medical Association Journal published in August 2008 that PPIs (Proton Pump Inhibitors, generic name: omeprazole brand names: Prilosec) may reduce calcium absorption, thus causing early onset osteoporosis and bone fracture among patients, especially those taking PPIs for five to seven years or longer. A similar study published in Journal of the American Medical Association (December 2006), also found that long-term, high-dose consumption of PPIs contributed to hip fractures among patients.

Even if your reaction isn’t something exotic like your skin falling off proton-pump inhibitors like Prilosec slows down the absorption of vitamin B12 which in turn causes a host of problems (heart disease, depression, fatigue, acceleration of the effects of other diseases which you may have like diabetes or arteriosclerosis).

And if you know someone who takes Prilosec OTC ask them how long they’ve been taking it. For some people it’s years. Not on and off for years. Daily. For Years. Even the Prilosec website states it’s designed to be a limited treatment (emphasis mine):

How long can I take Prilosec OTC?
Prilosec OTC is a 14-day regimen that is indicated for three courses per year. While it is safe to treat frequent heartburn regularly with Prilosec OTC, it is strong enough to mask more serious conditions. If you want to take more than the three indicated courses, first consult your doctor.

Even those over-the-counter remedies you might think are harmless are not! Tagamet (Zantac, Pepcid, or other H2 blockers) not only prevent your stomach from achieving its natural environment (not a small issue, read the books recommended below for more info), it interferes with your body’s ability to detoxify the toxins we ingest every day.

So acid isn’t the problem, it’s supposed to be in your stomach (in fact, your stomach might not be producing enough). Where it’s not supposed to be is in your esophagus. So the “cure” for acid reflux lies not in addressing the acid, but in the reflux. The root of the problem is the connection between your stomach and your esophagus, your LES (lower esophageal sphincter). If your LES isn’t doing its job acid escapes and that’s when problems arise.

As with many health problems it keeps coming back around to this…diet, exercise and common sense.

Suggested reading (get informed!):

Why Stomach Acid is Good for You Natural Relief from Heartburn, Indigestion, Reflux and GERD by Jonathan Wright, M.D. and Lane Lenard, Ph.D. This is the definitive guide on why your stomach needs to do what nature designed it to do and why messing with it is a bad idea. Dr. Wright found many of his patients with acid reflux, especially those over 50, actually have too little stomach acid and should supplement with hydrochloric acid. How many acid reflux sufferers are taking drugs to suppress their stomach acid when they should be doing the opposite?!